- 1 Amitriptyline cocktail
- 2 Carbon monoxide poisoning
- 3 Chloroquine cocktail
- 4 Cyanide poisoning
- 5 Darvon cocktail
- 6 Diphenhydramine
- 7 Fentanyl
- 8 Hydrogen sulfide
- 9 Methadone
- 10 Morphine and heroin
- 11 Nicotine
- 12 Pentobarbital
- 13 Overdose effects
- 14 See also
Carbon monoxide poisoning
Morphine and heroin
|Suicide method ratings|
|Preparation and administration (5)||5|
|Speed of effect (5)||4|
|Safety to others (5)||5|
|Total score (50)||44|
Pentobarbital (trade name: Nembutal) is a drug from the barbiturate class. It was widely used during the 1940s and 1950s as a sleeping pill (i.e. hypnotic) or anti-anxiety drug (i.e. sedative). Unlike modern sleeping pills, Nembutal is highly lethal in overdose. Because it is very reliable and brings about peaceful death, it is one of drugs of choice for assisted suicide. Nembutal is used by euthanasia organizations in the United States (Oregon Death With Dignity Act), Switzerland (Dignitas) and The Netherlands.
Since it was so easy to overdose on Nembutal (whether accidentally or intentionally), it was almost universally taken off the market and replaced by safer sleeping pills. Nembutal was removed from the Australian prescribing schedule in 1998. However, Nembutal remains in use by veterinary surgeons in order to euthanase bigger animals. Many people were successful in obtaining veterinary Nembutal for their suicide. The famous American actress Marilyn Monroe supposedly used Nembutal to end her life.
The brand name "Nembutal" was coined by Dr. John S. Lundy, who started using it in 1930, from the structural formula of the sodium salt—Na (sodium) + ethyl + methyl + butyl + al (common suffix for barbiturates). Nembutal is trademarked and manufactured by the Danish pharmaceutical company Lundbeck, and is the only injectable form of pentobarbital approved for sale in the United States.
Comparison to other methods
Nembutal is a proven, reliable drug that brings about a peaceful death. Almost no failures are known, despite large statistics (for example, the Swiss Template:Interwiki reported 840 exits with no single failure).
Nembutal is supposedly very difficult to obtain, as its sole remaining human use in the USA is in liquid form for use as a sedative and anesthetic in hospitals. Because of this, no brick-and-mortar or mail-order pharmacy sells Nembutal; any such site that claims to do so is likely fake. Also, veterinary Nembutal is a liquid and not in pill-form, which means that it has a shorter shelf life. On the other hand, Seconal (secobarbital), a short acting barbiturate that is as powerful as Nembutal if not more powerful, is still available in capsule form in the USA and probably the UK. However, it is very rarely, if ever, prescribed.
As a practical matter, Nembutal is not hard to obtain at all for those who have a few (or several) hundred dollars and knowledge of what supplier to ask. Specifically, the Peaceful Pill Handbook has a chapter, Obtaining Nembutal, with lists of trusted suppliers; updates to this list are made available to those who subscribe to the digital edition of the book.
There are a few views available on the lethal dose, all held by medical professionals. They are illustrated below.
- Dr. Nitschke in his The Peaceful Pill Handbook states, "Administration is a matter of dissolving ~10gm of the powder in ~50ml of water and drinking. . . . . If the powder is analyzed to be pure, and if ingested in the recommended amounts, Chinese Nembutal powder will (not might) lead to a reliable and peaceful death. . . . . The minimum lethal dose is 6gms. If the substance is pure, a purchase of 25gm of 95% pure soldium pentobarbital is more than enough for two adults."
- In The Netherlands, doctors who offer to help with hastening death, provide a drink with 9 grams of pentobarbital or secobarbital.
- The research committee of Dr. Admiraal, belonging to a Dutch euthanasia group, deemed that nobody has ever woken up after ingestion of 6 grams of a barbiturate if not tolerant to the drug, provided no vomiting occurred.
- In the book Departing Drugs by Chris Docker and Cheryl Smith, it is suggested on page 64 that 3.5 grams are the lethal dose of secobarbital. Dr. Admiraal deems that 3.5 grams can not be considered as sufficient to be reliably lethal, but that 6 grams would definitely be the sufficient amount.
Nembutal Sodium Solution
Nembutal Sodium Solution (pentobarbital sodium injection) is a sterile solution for intravenous or intramuscular injection. Each mL contains pentobarbital sodium 50 mg, in a vehicle of propylene glycol, 40%, alcohol, 10% and water for injection, to volume. The pH is adjusted to approximately 9.5 with hydrochloric acid and/or sodium hydroxide.
Nembutal Sodium is a short-acting barbiturate, chemically designated as sodium 5-ethyl-5-(1-methylbutyl) barbiturate.
As far as the authors of this wiki are aware, there were a few reports from alt.suicide.methods members, who said to have purchased liquid pentobarbital sodium in Tijuana, Mexico. This is also backed by the book of Dr. Nitschke, The Peaceful Pill Handbook, which features an extensive part about how to make a successful journey to Tijuana in order to buy Nembutal. We will do our best to bring this section and post parts of it in this page along with people's reports from there.
- See a video report of one travel published on YouTube: here.
- There are possible plans to close a Mexican source.
- A report by someone who went to Mexico: it may be not that easy! Read it here.
- Some more information from the New York times.
Barbiturates in general
The barbiturates are non-selective CNS depressants which are primarily used as sedative hypnotics and also as anticonvulsants in subhypnotic doses. The barbiturates and their sodium salts are subject to control under the Federal Controlled Substances Act. Specifically, pentobarbital is a Schedule II controlled substance whose illegal possession is punishable by one year in prison for a first-time drug offender, pursuant to Template:Usc.
Barbiturates are substituted pyrimidine derivatives in which the basic structure common to these drugs is barbituric acid, a substance which has no CNS activity (thus, barbituric acid alone would not be lethal). CNS activity is obtained by substituting alkyl, alkenyl, or aryl groups on the pyrimidine ring.
Mechanism of action
Barbiturates have direct effects on the benzodiazepine-GABAa-chloride receptor complex in enhancing chloride flux, hyperpolarisation of the membrane, and neural inhibitory effects. As opposed to benzodiazepines, barbiturates do not only exert their inhibitory effect through the GABA receptors, but they also open independently more ion channels for chloride influx through the cell's membrane. That is why their inhibitory impact on the CNS is so severe. Barbiturates shut down the reticular formation in the brain, i.e the neural pathways in the brain.
Tolerance and withdrawal
The prolonged use of barbiturates leads to tolerance. Also, cross-tolerance between barbiturates and benzodiazepines can be presented, since both drugs act through the GABA receptors. Hence, it is suggested that a period of 3-4 weeks of withdrawal can reverse the tolerance and this process is indeed needed for having one's attempt be a reliable one.
The Nembutal Cocktail
Nembutal, unlike other lethal drugs, does not require any additional drugs. Only anti-emetic drugs must be taken in advance, in order to prevent any vomiting from occurring.
|Antiemetic drugs must be taken beforehand|
|Liquid pentobarbital (Nembutal)||6 grams (see different opinions below)|
- 1-2 grams of Phenytoin (Dilantin) will potentiate the cocktail.
Time To Death
Experience in The Netherlands has learned that after ingesting 9 grams of either pentobarbital or secobarbital, death generally occurs within two hours (see the tables below).
- Time to death after oral ingestion of 9 grams pentobarbital (102 cases) or secobarbital (21 cases)
Time to death data in the Dutch euthanasia group: 123 cases from A. Horikx, staff member of the Royal Dutch Pharmaceutical Society.
|Time To Death||Number of
|0-15 minutes||39 people (32%)|
|16-30 minutes||40 (33%)|
|30-60 minutes||21 (17%)|
|1-2 hours||9 (7%)|
|Euthanasia by doctor after > 2 hours waiting||9 (7%)|
|Unknown time||5 (4%)|
- Time to death after oral ingestion of 10-12 grams pentobarbital (261 cases)
Similarly to the table displayed above, the following table (mentioned in Guide to a Humane Self-Chosen Death) provides the time to death as reported by the right-to-die organization "Exit deutsche Schweiz" (which literally translates as Exit German Switzerland).
|Time To Death||Number of
|0-15 minutes||70 people (27%)|
|16-30 minutes||115 (44%)|
|30-60 minutes||44 (17%)|
|1-2 hours||11 (4%)|
|2-12 hours||20 (8%)|
|> 12 hours||1 (0.4%)|
A pentobarbital overdose is an amount taken in excess of that which is medically recommended. Two to ten grams can cause death. CNS and respiratory depression which may progress to Cheyne-Stokes respiration, areflexia, constriction of the pupils to a slight degree (though in severe poisoning they may show paralytic dilation), oliguria, tachycardia, hypotension, lowered body temperature, and coma. Typical shock syndrome (apnea, circulatory collapse, respiratory arrest, and death) may occur.
In extreme overdose, all electrical activity in the brain may cease, in which case a "flat" EEG normally equated with clinical death cannot be accepted. This effect is fully reversible unless hypoxic damage occurs. Consideration should be given to the possibility of barbiturate intoxication even in situations that appear to involve trauma.
Complications such as pneumonia, pulmonary edema, cardiac arrhythmias, congestive heart failure, and renal failure may occur. Uremia may increase CNS sensitivity to barbiturates. Differential diagnosis should include hypoglycemia, head trauma, cerebrovascular accidents, convulsive states, and diabetic coma.
- The Peaceful Pill Handbook by Dr. Philip Nitschke
- Guide to a Humane Self-Chosen Death by Dr. Pieter Admiraal